Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe

BACKGROUND: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents. METHODS: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula. RESULTS: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm(3) (394; 1037) (children aged ≥ 1 and 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes. CONCLUSIONS: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive

A prospective study on neonatal mortality and its predictors in a rural area in Burkina Faso: can MDG-4 be met by 2015?

OBJECTIVE: To measure the neonatal mortality rate (NMR) and investigate its predictors in a rural area of Burkina Faso. STUDY DESIGN: A cohort of infants born in 24 villages in Banfora region was followed until the children were 6 months old. We estimated the risk of neonatal death and used logistic regression to identify its predictors. RESULT: Among 864 live births followed to day 28, there were 40 neonatal deaths, a NMR of 46.3 per 1000 live births (95% confidence intervals (CI): 22 to 70). Multivariable regression identified twin birth (OR=11.5, 95% CI: 4.5 to 29.8), having a nulliparous mother (odds ratio (OR)=4.3, 95% CI: 1.5 to 12.1), and birth into a polygynous household (OR=2.1, 95% CI: 1.0 to 4.7) as main predictors of neonatal death. CONCLUSION: The burden of neonatal mortality in rural Burkina Faso is very high and the observed NMRs in a predominantly rural country suggest that it is unlikely Burkina will meet fourth Millennium Development Goal (MDG-4) by 2015

Envenimation avec décès néonatal après morsure de vipère pendant la grossesse

English Title: Envenomation with neonatal death after snakebite during pregnancyEnglish AbstractDuring pregnancy, a snake bite can be severe and fatal to the mother and the fetus. However, if ophidian envenomations in pregnant woman are well described in the literature, neonatal aspects of this accident are little discussed. In order to discuss the deleterious consequences of envenomation, the difficulties of diagnosis and management in the newborn after snake bite in the pregnancy, here we report a case of bite of Viper in a pregnant woman who gave birth to a 33 weeks preterm baby. In the absence of anti venom, the woman and her baby died, one by hemorrhagic shock and the other by respiratory distress, infection and renal failure.Keywords: Snakebite; Pregnancy; Envenomation; Neonatal deat

Infection VIH chez les enfants au CHU Yalgado Ouédraogo, Ouagadougou: Etude rétrospective sur 237 cas colligés de 2005 à 2011 dans le département de pédiatrie

Engish Title: HIV infection in children at Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso: a retrospective study on 237 cases from 2005 to 2011 at the pediatric departmentEnglish AbstractThe management of HIV -infected children is still a challenge today in Burkina Faso. The purpose of this study is to describe the outcome of HIV-infected children treated and followed in the Pediatric Service of CHU-Yalgado Ouedraogo (CHUYO) from 2005 to 2011. This is a retrospective study based on records of children infected with HIV and enrolled for treatment from 2005 to 2011 in the Department of Pediatrics of the University Hospital Y algado Ouedraogo in Ouagadougou. During this period, 237 children were enrolled. The median age was three years. Global acute malnutrition, chronic gastroenteritis and respiratory infections were common at baseline with respectively 50.6% and 38.4%; 37, 6%. Over 80% of patients were at WHO stage III or IV. The mean CD4 count at initiation of treatment was 14.9 ± 9.4% and the average rate of hemoglobin 9.4 g/dl. Eleven patients (4.6%) had changed ART. The mortality rate was 17%. One out of 10 patients was lost to follow up.Innovative strategies are needed at this center to allow earlier identification of infected children, availability of biological tests and retention of patients in the center.Keywords: pediatric HIV, HAART, Burkina Fas

Recours therapeutique en pediatrie: place de l'automedication chez les enfants re~us au Centre Hospitalier Universitaire Charles de Gaulle de Ouagadougou (Burkina Faso)

L'itineraire therapeutique fait reference aux parcours utilises par les individus pour !'obtention de soins en developpant des strategies les mettant en relation avec divers lieux de traitements. L' objectif de notre travail etait d'etudier les itineraires therapeutiques des enfants rei(US au CHUP CDG. 11 s'est agi d'une etude descriptive transversale qui s'est deroulee en trois mois. Un guide d'entretien oral a permis de recueillir les donnees aupres des parents consentants. Les parents ou  accompagnants de 300 enfants hospitalises ont participe a I' etude. La residence de la famille etait surtout la zone urbaine dans 74% des cas. Le delai de consultation etait de 1 a 2 jours dans 69,7% des cas. Le nombre moyen de recours therapeutiques etait de 3 avec des extremes de 1 et 7. Parmi les symptomes presentes par les enfants, la fievre (56,3 %), la diarrhee (9 %) et la toux (6 %) etaient les plus frequents. Devant la fievre 60,9% des parents ont eu recours a l'automedication. Cette automedication occasionne un retard de consultation qui pourrait etre prejudiciable aux enfants.Mots-cles : itineraires therapeutiques, enfants, automedication, Burkina Faso.Care seeking in pediatric wards : place of self-medication among the children received at teaching hospitals center Charles de Gaulle (Burkina Faso) The course of therapy refers to procedures used by individuals to obtain care by developing strategies that put them in relation with various treatment centers. The objective of our study was to investigate the course of therapy used by children received at the University Child Hospital Center (CHUP-CDG). This is a descriptive cross-cutting study conducted over three months. Data collection was done through an oral discussion guide with consenting parents. Parents or home nurses of 300 children hospitalized participated in the study. Most of children's families were living in urban area in 74% of cases. Consultation time at CHUP-CDG was 1 to 2 days in 69.7% of cases. The average number of therapeutic use for this disease was 3 with extremes between 1 and 7. Most common symptoms found in children included fever (56.3% ), diarrhea (9%) and cough (6% ). In case of fever, 64% of parents first practice self-medication. This self-medication is source of delays in consultations, notably in case of fever.Keywords: therapeutic itinerary, children, self-medication, Burkina Faso.

Evaluation du coût médical direct de il prise en charge du syndrome drépanocytaire majeur de l'enfant à Ouagadougou

English AbstractThe sickle cell disease is a major problem of public health in Burkina Faso. Prevalence of the major sickle syndromes affect approximately 8,42 % of the patients in a hospital environment. The families of these children spend a lot of money on vaccines, medicine, complementary examinations. The objective of our work was to estimate the annual expenses to cause by the sickle disease within families. To this end we led to the pediatric university hospital Charles de Gaulle and to the holy health center Camille of Ouagadougou a retrospective covering study a period of one year going from January 1st till December 31st, 2011 on hospitalized or consultant children from 0 to 15 years old to these structures. The medical  cases of these patients were of use to us as sources of data which were collected on an index of collection and treated with the software " Sphinx Lexica ". The average cost of a care in ambulatory is estimated at 41 838,82 FCFA a year and the average cost of the care in hospitalization to 106 688,70 FCFA. The sickle cell disease thus constitutes a considerable economic weight for our patients and especially families where from the necessity of an implication of the political powers for the implementation of well codified protocols and a subsidy for the care of this affection.Keywords: sickle cell disease major, child, taken care, medical cos

Neonatal azithromycin administration for prevention of infant mortality.

BackgroundBiannual mass azithromycin administration reduces all-cause childhood mortality in some sub-Saharan African settings, with the largest effects in children aged 1-5 months. Azithromycin has not been distributed to children &lt;1 month due to risk of infantile hypertrophic pyloric stenosis (IHPS).MethodsThis 1:1 placebo-controlled trial, randomized neonates aged 8-27 days to a single oral dose of azithromycin (20 mg/kg) or equivalent volume of placebo in 5 regions of Burkina Faso during 2019 and 2020. The primary outcome was all-cause mortality at 6 months of age. Infants were evaluated at 21 days after treatment and at 3 and 6 months of age for vital status; family and provider surveillance for IHPS continued throughout.ResultsOf 21,832 enrolled neonates, 10,898 were allocated to azithromycin and 10,934 to placebo. At 6 months of age, 92 infants had died, 42 (0.44%) in the azithromycin group and 50 (0.52%) in the placebo group (hazard ratio 0.85, 95% confidence interval 0.56 to 1.28, P=0.46). A single IHPS case was detected, which was in the azithromycin arm. Serious adverse events, including death and hospitalization within 28 days of treatment, occurred in 0.27% of infants in the azithromycin group and 0.14% in the placebo group, for an absolute risk difference 0.14 percentage points, 95% confidence interval 0.01 to 0.26.ConclusionsOverall mortality was lower than anticipated when the trial was designed, thus limiting its power. The available data do not support the routine use of azithromycin for prevention of mortality in neonates in sub-Saharan African settings similar to the one in which this trial was conducted.Trial registrationClinicalTrials.gov NCT03682653